Our Proprietary RCM Collections Software
Our Proprietary Software
Over 33+ years in the RCM business, we have developed intellectual property software that determines the success rate of initial claim submission by payer and by EIN. The reciprocal of the success rate is the quantity of inventory that needs to be worked. We call this report the “Client Data Integrity.” For example, if 87% of the CPT lines submitted initially were paid, then 13% of the CPT lines make up the inventory of claims that need follow-up/attention.
Our intellectual Property (IP) software bar codes each claim (inventory) as it’s submitted to the various payers. The technology estimates the date the claim should be paid based on historical processing of that payer in that region. If needed, we can override the technology and change the filters (days). For example, if the inventory is going to a Medicaid plan in Minnesota and the software knows the average processing time historically is 45 days, then the inventory will be marked for 46 days. On the 46th day, the software automatically will check that claim’s payment field in our system and if it’s blank, it will flag the inventory/claim to be worked.
The inventory can then be routed to an AR resource. The AR specialist who is assigned the claim now “owns” the claim. This is important because the AR specialists’ compensation, in part, is tied to how successful they are in working the claim and turning that inventory into cash. The client, the vendor, and the vendor’s resource are all perfectly aligned.
The AR specialist success is also tracked by the IP software. The software examines the work of each AR specialist and calculates a percentage of success based on the inventory they worked. We call this report “Effectiveness by User.” If the percentage is >80%, we leave that specialist alone. If their success rate is between 60-80%, we target specialized training for the specialist. We know exactly what type of training they need because we know the claims they worked in which they did NOT get paid. Training is conducted by our Director of Training. If they are consistently <60% after several training sessions, we wish them well to work at some other physician RCM company.
How do we know it works? We have a full-time auditor who randomly audits all functions (Charge entry/Cash Applications/AR) being performed by ALL staff and reports her findings to the executive team for action by the Director of Training. The audits are against the written documentation of each client stored in Microsoft Office 365/Sharepoint. This resource is a CPA and JD.
This process of front end visibility of initial claim submission, claim tracking and AR resource evaluation is a process innovation that separates our firm from all others.
Revenue Cycle Management Specialties
After over 3 decades in the physician RCM business, the company and its team members also have experience in:
- Allergy & Immunology
- Assistant surgery
- Critical care
- Geriatric Medicine
- Hospitalist and Skilled Nursing Facilities
- Infectious disease
- Nuclear Medicine
- Orthopaedic Trauma
- Primary care/Internal medicine
- Sleep Medicine
- Sports Medicine
At revMD, its not about the particular CPT code that needs to be reimbursed, its about the actions taken when the CPT code is ignored or inappropriately denied by payers.
Are You Coding 100% of the Services You Provide?
As the best alternative in healthcare revenue cycle management, revMD gives medical practices the superior advantage they need to build profitable practices.
Our advantage is the unique services we provide, our niche specialization in medical practice coding, billing and collections and our passion for collecting every dollar you deserve. Both practice-based and hospital-based physician groups benefit not only from our RCM services but also the cloud based technology and network support that integrate them seamlessly.